The Contact Sports Dilemma

The National Football League’s 2018
season has triggered sharp debate over whether the elite professional league
has done enough to protect its players from concussions and other injuries or
has gone too far and robbed the sport of its essential vitality. The same
health concerns are relevant to other head-contact sports such as boxing,
hockey, and soccer, and to athletes of all ages, from peewee leagues through
college and professional sports.

Players, parents, coaches, and sports administrators must confront a host of
ethical issues, including whether all contact sports should be banned, at least
at certain age levels, or whether that would rob the nation of sporting events
that can unify communities and, some say, build character through discipline
and teamwork. Huge conflicts of interest impede sound policy at virtually every
level.

For many years the NFL downplayed the effects of head injuries and claimed
there were no long term-effects on players. But in recent years the league
settled a class action suit with thousands of players for $1 billion. Although
the league says there was extensive fraud in documenting brain damage among
players, there is no doubt that many, many players were grievously injured.

The league has taken some steps to protect its players from brain injury, most
notably by making helmet-to-helmet hits illegal. Unfortunately, enforcement has
been spotty. The league has also introduced 47 rule changes since 2002. They
include requiring more medical personnel to help diagnose head injuries, more
careful treatment of players suspected of sustaining a concussion, and banning
certain plays and procedures deemed too risky.

Many fans and players—and President Donald Trump—have complained that the rules
go too far. Mr. Trump, as a candidate, derided the league for benching players
who received “a little ding on the head.” After taking office, he complained
that the penalties for hard hits were “ruining the game.”

Some players, deeply worried about potential brain damage, have retired
rather than face additional hits. John Urshel, an offensive lineman for the
Baltimore Ravens who is working toward a doctorate in math at M.I.T., retired
at age 26. While recovering from a concussion, he found it tough to do
high-level math and had “really hard times thinking through things and
visualizing things.” Similarly, Chris Borland, a young linebacker for the San
Francisco 49ers, quit at age 24 after an outstanding rookie season because he
feared getting brain damage if he continued to play.

On the other hand, many players, fans, and sports announcers complained
mightily when the league tightened its rules against roughing the passer this
season. One coach even asserted that his defensive end injured himself when he
tried to avoid putting his full weight on a quarterback he sacked.

While the league recommends wearing protective padding to make football
safer, some macho players actually reduce protective padding to a minimum. They
believe that makes them faster and more nimble and improves their appearance on
television.

The chief research on traumatic brain injuries and chronic traumatic
encephalopathy (CTE) among NFL players has been done by a group at Boston
University school of medicine, led by Dr. Ann McKee (a Dana Alliance for Brain
Initiatives member), that maintains a brain bank of tissues donated by players
or their families. McKee found that 110 of 111 brains of deceased NFL players
had evidence of CTE. The findings were unavoidably skewed by selection bias,
but even so it was a stark warning of troubles ahead.

In none of McKee’s studies did concussions correlate with CTE. Rather, the
cumulative number of sub-concussive hits over years of exposure correlated best
with the presence and severity of CTE. The researchers also examined brains
from the Canadian Football League and from high school and college players.
High school players typically had mild cases but even mild cases had cognitive,
behavioral, and mood symptoms. Eric Pelly, a high school football and rugby
player, died at age 18, ten days after his fourth concussion. His brain showed
early stage CTE.

A team led by Dr. Sam Gandy at Mt. Sinai medical school in New York
is exploring the use of scans to test for CTE in players still living. If he
succeeds, it should be possible to let players know what brain damage, if any,
they have already suffered and perhaps find drugs to treat and prevent such
damage.

What should be done in the absence of better knowledge of how to predict
the risks to an individual player? Research has shown that children who start
playing tackle football before age 12 experience an early onset of cognitive,
behavioral, and mood symptoms associated with CTE. Thus it would surely be wise
to outlaw head-contact sports for pre-teens. Recognizing the inevitable, the NFL
and its foundation are promoting flag football for this age group as an entry
point to learn skills and teamwork without butting heads.

It might also make sense to ban all head-contact sports until age 18,
when players are presumably mature enough to decide what risks they want to
take, just as they decide whether to drink, smoke, or join the military.

It will be a struggle to eliminate conflicts of interest. Some parents
view football as a family tradition and a possible ticket to a college
scholarship and so may gloss over the risks. The governing authorities of
professional and college football, and many individual colleges as well, have
such a stake in their enormously profitable football programs that they can’t
always be trusted to put the health of their players foremost. The NFL stopped
funding research on brain injuries by the National Institutes of Health (NIH) after
it was unable to funnel money to a researcher it deemed friendly and when it
failed to oust a lead investigator it deemed too critical. To its credit, the
Ivy League has eliminated all full-contact hits from regular season practices
and changed its kickoff rules to reduce high-speed collisions, thus drastically
reducing the rate of concussions.

Can science and technology ride to the rescue? A multi-center study
funded by NIH will study the brains in three groups of living athletes—former
NFL players and former college players, with or without CTE, and a control
group of people who have never played contact sports— to better understand the
evolution of brain damage. Meanwhile, researchers at Columbia University are
working on EEG-embedded helmets that can detect sub-concussive events as they
occur and send encrypted findings to a coach on the sidelines to take action if
necessary.

The concerns over brain damage have had the salutary effect of reducing
participation in youth football. The number of high school football players has
been declining in recent years. Some schools don’t have enough players to put
the standard 11 men on the field at one time,. Some join leagues that play only
six or eight players at a time. Others drop football entirely. The accumulating
evidence of brain damage is just too powerful to ignore.

Phil Boffey is former deputy
editor of the New York Times
Editorial Board and editorial page writer, primarily focusing on the impacts of
science and health on society. He was also editor of Science Times and a member of two teams
that won Pulitzer Prizes.